Charles De Ponthaud, Alexandra Nassar, Safi Dokmak, Thibaud Bertrand, Julien De Martino, Clément Pastier, Antoine Castel, Raffaele De Rosa, Mehdi Boubaddi, Abdallah Iben-Khayat, Fabio Giannone, Elsa Jolly, Jonathan Garnier, Clément Louis-Gaubert, Alessandro D Mazzotta, Marie André, Johan Gagnière, Manon Viennet, François-Régis Souche, Reza Kianmanesh, Renato Micelli Lupinacci, Jean-Marc Regimbeau, François Paye, Pietro Addeo, Alexis Laurent, Morgan Vandermeulen, Robert Caiazzo, Mehdi El Amrani, Christophe Tresallet, Alexandre Doussot, Martin Brunel, Lionel Jouffret, Amandine Pinto, Alain Valverde, Rodolfo Romero Vece, Régis Fara, Samir Mahfouf, Benjamin Darnis, Amine Chamakhi, Jeremie Thereaux, Jean Lubrano, Edouard Girard, Julie Veziant, David Jérémie Birnbaum, Jérôme Danion, Helene Corté, Johanna Zemour, Tullio Piardi, Anne de Carbonnières, Emilia Ragot, Alban Zarzavadjian Le Bian, Patrice David, Laurent Brunaud, Emilie Lermite, Laura Chreim, Ana Lucia Charlaix, Jean Gugenheim, Lilian Schwarz, Jean Marc Bigourdan, Bertrand Le Roy, Elias Karam, Rami Rhaiem, Jean-Michel Fabre, Jean-Baptiste Lequeu, Marie Noirault, Ahmet Ayav, Olivier Soubrane, Nicolas Regenet, Olivier Turrini, Fabrice Muscari, Patrick Pessaux, Baudouin Thébault, Christophe Laurent, Laurent Sulpice, Alain Sauvanet, David Fuks, Sébastien Gaujoux
{"title":"微创左侧胰腺切除术中的转归：原因和后果的全国性研究。","authors":"Charles De Ponthaud, Alexandra Nassar, Safi Dokmak, Thibaud Bertrand, Julien De Martino, Clément Pastier, Antoine Castel, Raffaele De Rosa, Mehdi Boubaddi, Abdallah Iben-Khayat, Fabio Giannone, Elsa Jolly, Jonathan Garnier, Clément Louis-Gaubert, Alessandro D Mazzotta, Marie André, Johan Gagnière, Manon Viennet, François-Régis Souche, Reza Kianmanesh, Renato Micelli Lupinacci, Jean-Marc Regimbeau, François Paye, Pietro Addeo, Alexis Laurent, Morgan Vandermeulen, Robert Caiazzo, Mehdi El Amrani, Christophe Tresallet, Alexandre Doussot, Martin Brunel, Lionel Jouffret, Amandine Pinto, Alain Valverde, Rodolfo Romero Vece, Régis Fara, Samir Mahfouf, Benjamin Darnis, Amine Chamakhi, Jeremie Thereaux, Jean Lubrano, Edouard Girard, Julie Veziant, David Jérémie Birnbaum, Jérôme Danion, Helene Corté, Johanna Zemour, Tullio Piardi, Anne de Carbonnières, Emilia Ragot, Alban Zarzavadjian Le Bian, Patrice David, Laurent Brunaud, Emilie Lermite, Laura Chreim, Ana Lucia Charlaix, Jean Gugenheim, Lilian Schwarz, Jean Marc Bigourdan, Bertrand Le Roy, Elias Karam, Rami Rhaiem, Jean-Michel Fabre, Jean-Baptiste Lequeu, Marie Noirault, Ahmet Ayav, Olivier Soubrane, Nicolas Regenet, Olivier Turrini, Fabrice Muscari, Patrick Pessaux, Baudouin Thébault, Christophe Laurent, Laurent Sulpice, Alain Sauvanet, David Fuks, Sébastien Gaujoux","doi":"10.1097/SLA.0000000000006685","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To identify risk factors for conversion, develop a predictive Conversion Risk Score (CRS), and assess the association between conversion and severe postoperative complications.</p><p><strong>Background: </strong>Conversion occurs in 15-30% of minimally invasive left pancreatectomies (MILP). Risk factors and potential negative impacts on postoperative outcomes are poorly described.</p><p><strong>Methods: </strong>Retrospective, nationwide, multicenter study including all MILP (laparoscopy and robot) performed between 2010 and 2021. Risk factors for conversion were identified by multivariate mixed model, and a CRS was developed on a \"training-set\" and validated (calibration diagrams and ROC curves) on a \"validation-set.\" The association between severe complications and conversion was assessed using a propensity score based on the main risk factors for severe complications: age, sex, BMI, ASA score, tumor malignancy, multi-organ resection, operative duration, blood loss, splenectomy.</p><p><strong>Results: </strong>2104 patients included from 55 centers. Conversion occurred in 15.6% of MILP. Its risk factors were male sex (OR=1.67;P=0.048), BMI≥25 kg/m2 (OR=2.15;P=0.004), history of laparotomy (OR=2.9;P<0.001), initial pancreatitis (OR=3.58;P=0.007), tumor size≥40 mm (OR=2.12;P=0.003), planned splenectomy (OR=2.63;P<0.001), unplanned splenectomy (OR=4.05;P=0.028), portal vein resection (OR=36.3;P=0.002), multi-organ resection (OR=12.97;P<0.001). A predictive CRS was created based only on preoperatively available variables (the first six), with scores ranging from 0 to 7, corresponding to a conversion risk of 2% to 100%. No association was observed with tumor malignancy, robotic approach, or pancreatectomy volume. Conversion was significantly associated with severe complications [OR=1.80(1.16-2.54)], independent of other risk factors for complications.</p><p><strong>Conclusions: </strong>Conversion during MILP can be predicted by CRS, aiding surgeons in decision-making, given its significant association with severe complications.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5000,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Conversion during Minimally Invasive Left Pancreatectomy: A Nationwide Study of Causes and Consequences.\",\"authors\":\"Charles De Ponthaud, Alexandra Nassar, Safi Dokmak, Thibaud Bertrand, Julien De Martino, Clément Pastier, Antoine Castel, Raffaele De Rosa, Mehdi Boubaddi, Abdallah Iben-Khayat, Fabio Giannone, Elsa Jolly, Jonathan Garnier, Clément Louis-Gaubert, Alessandro D Mazzotta, Marie André, Johan Gagnière, Manon Viennet, François-Régis Souche, Reza Kianmanesh, Renato Micelli Lupinacci, Jean-Marc Regimbeau, François Paye, Pietro Addeo, Alexis Laurent, Morgan Vandermeulen, Robert Caiazzo, Mehdi El Amrani, Christophe Tresallet, Alexandre Doussot, Martin Brunel, Lionel Jouffret, Amandine Pinto, Alain Valverde, Rodolfo Romero Vece, Régis Fara, Samir Mahfouf, Benjamin Darnis, Amine Chamakhi, Jeremie Thereaux, Jean Lubrano, Edouard Girard, Julie Veziant, David Jérémie Birnbaum, Jérôme Danion, Helene Corté, Johanna Zemour, Tullio Piardi, Anne de Carbonnières, Emilia Ragot, Alban Zarzavadjian Le Bian, Patrice David, Laurent Brunaud, Emilie Lermite, Laura Chreim, Ana Lucia Charlaix, Jean Gugenheim, Lilian Schwarz, Jean Marc Bigourdan, Bertrand Le Roy, Elias Karam, Rami Rhaiem, Jean-Michel Fabre, Jean-Baptiste Lequeu, Marie Noirault, Ahmet Ayav, Olivier Soubrane, Nicolas Regenet, Olivier Turrini, Fabrice Muscari, Patrick Pessaux, Baudouin Thébault, Christophe Laurent, Laurent Sulpice, Alain Sauvanet, David Fuks, Sébastien Gaujoux\",\"doi\":\"10.1097/SLA.0000000000006685\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To identify risk factors for conversion, develop a predictive Conversion Risk Score (CRS), and assess the association between conversion and severe postoperative complications.</p><p><strong>Background: </strong>Conversion occurs in 15-30% of minimally invasive left pancreatectomies (MILP). Risk factors and potential negative impacts on postoperative outcomes are poorly described.</p><p><strong>Methods: </strong>Retrospective, nationwide, multicenter study including all MILP (laparoscopy and robot) performed between 2010 and 2021. Risk factors for conversion were identified by multivariate mixed model, and a CRS was developed on a \\\"training-set\\\" and validated (calibration diagrams and ROC curves) on a \\\"validation-set.\\\" The association between severe complications and conversion was assessed using a propensity score based on the main risk factors for severe complications: age, sex, BMI, ASA score, tumor malignancy, multi-organ resection, operative duration, blood loss, splenectomy.</p><p><strong>Results: </strong>2104 patients included from 55 centers. Conversion occurred in 15.6% of MILP. Its risk factors were male sex (OR=1.67;P=0.048), BMI≥25 kg/m2 (OR=2.15;P=0.004), history of laparotomy (OR=2.9;P<0.001), initial pancreatitis (OR=3.58;P=0.007), tumor size≥40 mm (OR=2.12;P=0.003), planned splenectomy (OR=2.63;P<0.001), unplanned splenectomy (OR=4.05;P=0.028), portal vein resection (OR=36.3;P=0.002), multi-organ resection (OR=12.97;P<0.001). A predictive CRS was created based only on preoperatively available variables (the first six), with scores ranging from 0 to 7, corresponding to a conversion risk of 2% to 100%. No association was observed with tumor malignancy, robotic approach, or pancreatectomy volume. Conversion was significantly associated with severe complications [OR=1.80(1.16-2.54)], independent of other risk factors for complications.</p><p><strong>Conclusions: </strong>Conversion during MILP can be predicted by CRS, aiding surgeons in decision-making, given its significant association with severe complications.</p>\",\"PeriodicalId\":8017,\"journal\":{\"name\":\"Annals of surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":7.5000,\"publicationDate\":\"2025-02-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/SLA.0000000000006685\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/SLA.0000000000006685","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
Conversion during Minimally Invasive Left Pancreatectomy: A Nationwide Study of Causes and Consequences.
Objectives: To identify risk factors for conversion, develop a predictive Conversion Risk Score (CRS), and assess the association between conversion and severe postoperative complications.
Background: Conversion occurs in 15-30% of minimally invasive left pancreatectomies (MILP). Risk factors and potential negative impacts on postoperative outcomes are poorly described.
Methods: Retrospective, nationwide, multicenter study including all MILP (laparoscopy and robot) performed between 2010 and 2021. Risk factors for conversion were identified by multivariate mixed model, and a CRS was developed on a "training-set" and validated (calibration diagrams and ROC curves) on a "validation-set." The association between severe complications and conversion was assessed using a propensity score based on the main risk factors for severe complications: age, sex, BMI, ASA score, tumor malignancy, multi-organ resection, operative duration, blood loss, splenectomy.
Results: 2104 patients included from 55 centers. Conversion occurred in 15.6% of MILP. Its risk factors were male sex (OR=1.67;P=0.048), BMI≥25 kg/m2 (OR=2.15;P=0.004), history of laparotomy (OR=2.9;P<0.001), initial pancreatitis (OR=3.58;P=0.007), tumor size≥40 mm (OR=2.12;P=0.003), planned splenectomy (OR=2.63;P<0.001), unplanned splenectomy (OR=4.05;P=0.028), portal vein resection (OR=36.3;P=0.002), multi-organ resection (OR=12.97;P<0.001). A predictive CRS was created based only on preoperatively available variables (the first six), with scores ranging from 0 to 7, corresponding to a conversion risk of 2% to 100%. No association was observed with tumor malignancy, robotic approach, or pancreatectomy volume. Conversion was significantly associated with severe complications [OR=1.80(1.16-2.54)], independent of other risk factors for complications.
Conclusions: Conversion during MILP can be predicted by CRS, aiding surgeons in decision-making, given its significant association with severe complications.
期刊介绍：
The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.
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